Solid organ transplantation during covid-19 pandemic: An international web-based survey on resources' allocation

ETHICS
Solid Organ Transplantation During COVID-19 Pandemic: An International Web-based Survey on Resources’ Allocation
Giovinazzo, Francesco MD, PhD1; Avolio, Alfonso W. MD1,2; Galiandro, Federica MD1; Vitale, Alessandro MD, PhD3; Dalla Riva, Giulio V. PhD4; Biancofiore, Gianni MD, PhD5; Sharma, Shivani MBPsS, CPsychol6; Muiesan, Paolo MD7; Agnes, Salvatore MD1,2; Burra, Patrizia MD, PhD8
Author Information
1 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

2 Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.

3 General Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria, Padua, Italy.

4 School of Mathematics and Statistics, University of Canterbury, Canterbury, New Zealand.

5 Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy.

6 Equality, Diversity and Widening Participation Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.

7 Department of Surgery, Liver Unit, University Hospital Birmingham, Birmingham, United Kingdom.

8 Department of Surgery, Oncology and Gastroenterology, Azienda Ospedaliera Universitaria, Padua, Italy.

Published online 11 February, 2021.

Received 28 August 2020. Revision received 31 October 2020.

Accepted 7 November 2020.

A.W.A. and F.G. contributed equally to the study as first author.

This study was supported in part by a research grant of the Catholic University of Rome and by a special grant from the Italian Society of Organ Transplantation.

The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation Direct.

A.W.A. and F.G. did concept and design. A.W.A., S.A., G.B., P.B., F.G., F.G., P.M., G.d.R., S.S., and A.V. participated in analysis and interpretation of data. A.W.A., F.G., and S.S. drafted of the article. A.W.A., G.d.R., and A.V. did statistical analysis. A.W.A. and F.G. obtained funding. S.A., A.W.A., P.B., G.B., F.G., F.G., G. D.R., P.M., S.S., and A.V. did critical revision of the article for important intellectual content. A.W.A. and P.B. did supervision.

A.W.A. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data management.

*A list of “COVID-19 and Solid Organ Transplant Study Group” is given in “Acknowledgments” footnote.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantationdirect.com).

Correspondence: Alfonso W. Avolio, MD, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del S.Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Largo A. Gemelli, 8, 00168 Rome, Italy. (alfonso.avolio@unicatt.it).

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Transplantation Direct 7(3):p e669, March 2021. | DOI: 10.1097/TXD.0000000000001115
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Abstract
Background.
Solid organ transplants (SOTs) are life-saving interventions, recently challenged by coronavirus disease 2019 (COVID-19). SOTs require a multistep process, which can be affected by COVID-19 at several phases.

Methods.
SOT-specialists, COVID-19-specialists, and medical ethicists designed an international survey according to CHERRIES guidelines. Personal opinions about continuing SOTs, safe managing of donors and recipients, as well as equity of resources’ allocation were investigated. The survey was sent by e-mail. Multiple approaches were used (corresponding authors from Scopus, websites of scientific societies, COVID-19 webinars). After the descriptive analysis, univariate and multivariate ordinal regression analysis was performed.

Results.
There were 1819 complete answers from 71 countries. The response rate was 49%. Data were stratified according to region, macrospecialty, and organ of interest. Answers were analyzed using univariate-multivariate ordinal regression analysis and thematic analysis. Overall, 20% of the responders thought SOTs should not stop (continue transplant without restriction); over 70% suggested SOTs should selectively stop, and almost 10% indicated they should completely stop. Furthermore, 82% agreed to shift resources from transplant to COVID-19 temporarily. Briefly, main reason for not stopping was that if the transplant will not proceed, the organ will be wasted. Focusing on SOT from living donors, 61% stated that activity should be restricted only to “urgent” cases. At the multivariate analysis, factors identified in favor of continuing transplant were Italy, ethicist, partially disagreeing on the equity question, a high number of COVID-19-related deaths on the day of the answer, a high IHDI country. Factors predicting to stop SOTs were Europe except-Italy, public university hospital, and strongly agreeing on the equity question.

Conclusions.
In conclusion, the majority of responders suggested that transplant activity should be continued through the implementation of isolation measures and the adoption of the COVID-19-free pathways. Differences between professional categories are less strong than supposed.